The nation's nursing shortage is one of the most stubborn issues facing hospitals today. Demand for nurses is growing, especially in cities with many healthcare facilities clustered together, like Houston. (Nurses could switch jobs among four large hospitals near Methodist and not even have to change their parking spaces.) The competition will most likely be heightened by laws like a pioneering measure passed by California in 1999, which sets minimum nurse-patient ratios for acute-care hospitals. The rule, now being implemented, has sparked concerns about costs and led to infighting about requirements for specific kinds of nurses. But other states are closely watching the experiment, and more legislation may follow.
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Yet older baby boomer nurses are retiring, and others--including younger nurses--are seeking better hours and pay in specialty jobs or management positions. And fewer new nurses are being turned out, as some women who once would have chosen nursing are instead becoming doctors or other healthcare professionals. A recent study found that more than 60 percent of registered nurses are now over 40. And researchers at the Harvard School of Public Health and Vanderbilt University project that if present trends continue, the nationwide shortage of nurses will exceed 400,000 by 2020. "The image of nursing in general is still poor, reinforced by TV," acknowledges Spinella, who has moved up through the nursing ranks over several decades. "There's still an image that a nurse is a handmaiden to physicians. And the way nurses are treated by many doctors is, unfortunately, still an issue."
Teamwork. That's why hospitals are getting creative about making nursing jobs attractive. While there are still plenty of old-fashioned recruiting wars--Methodist, too, chases recruits at top nursing schools and has offered existing employees bonuses for referring nursing candidates--hospitals are finding that they must address core issues behind the nursing shortage to cement real change. A survey of acute-care hospitals in Washington State in 2002 found that higher pay did not help recruiting and retention of nurses as much as better working conditions--including teamwork among various parts of the hospital's staff--and improved nurse-patient staffing ratios.
So hospitals, especially in competitive markets like Texas and California, are making nursing more appealing by using fewer outside nurses, emphasizing education and promotion opportunities, and giving nurses more authority. Steps Methodist has taken include:
Making nurses and nursing supervisors a key part of the hospital's governance process. Methodist has developed "councils" of nurses that meet regularly to discuss patient care and administrative issues. Their concerns and views are passed along to administrators. Nurses also sit on interdisciplinary councils where they can express their concerns to physicians and other professionals. And each department assigns a medical director to a nursing unit, so nursing supervisors have an advocate in the larger organization.
Offering career progression incentives to reward nurses for remaining with the hospital. These include tuition reimbursement for continued studies.
Creating a pool of staff nurses who can provide backup, so that nurses are not forced to work frequent double shifts and so that relief nurses are familiar with hospital procedures. Staffing such a pool in the midst of the nursing shortage is difficult, Methodist's nursing supervisors acknowledge, but it is key to operating with no outside nurses.
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